Diagnostic accuracy of stroke volume variation for predicting fluid responsiveness in children undergoing cardiac surgery: A systematic review and meta‐analysis

Abstract

Background Stroke volume variation appears to be reliable for predicting fluid responsiveness in adults, and its predictive value in pediatric patients has been recently reported. However, its predictive value in children undergoing cardiac surgery is unclear. Methods A review and meta‐analysis were performed on the diagnostic utility of stroke volume variation for predicting fluid responsiveness in children undergoing cardiac surgery. All relevant articles for prospective research assessing the value of stroke volume variation were searched in the Embase, MEDLINE (PubMed), and Cochrane databases through March 2020. The primary outcome was the accuracy of stroke volume variation for predicting fluid responsiveness in children. The combined data were analyzed by a meta‐analysis. Publication quality was assessed using the QUADAS (quality assessment for studies of diagnostic accuracy, maximum score) standard guidelines. Results Six articles were included in the meta‐analysis, following the search strategy. A total of 251 children were included from 6 prospective studies. Fluid therapy for all patients used crystalloids or colloids. The results of the analysis revealed a pooled diagnostic odds ratio of 8.23 (95% CI: 3.07–22.11), pooled sensitivity of 0.73 (95% CI: 0.64–0.80), and pooled specificity of 0.66 (95% CI: 0.58–0.74). Additionally, the overall area of the summary receiver operating characteristic curve was 0.78. There was significant moderate heterogeneity in these studies (p < .05, I2 = 42.1%) due to thresholds. Conclusions There was some heterogeneity due to thresholds in the included studies. An evaluation of stroke volume variation may represent a reliable predictor of fluid responsiveness in children undergoing cardiac surgery. After operative cardiac output optimization, the possible impact of goal‐directed fluid treatment depending on stroke volume variation on the perioperative outcome in the children population should subsequently be assessed.

Point‐of‐care ultrasonography to predict fluid responsiveness in children: A systematic review and meta‐analysis

“…The most studied variables were ∆Vpeak and ∆IVC, however, only the former was found to be a reliable predictor, with an AUSROC of 0.89 (95% CI, 0.86–0.92), and pooled sensitivity and specificity of 84% and 82%, respectively. These values suggest that ∆Vpeak has the potential to be the most accurate predictor of fluid responsiveness currently available in children 1,38,39 . Other ultrasound predictors have their applicability limited by the poor evidence supporting their use.…”

“…These values suggest that ∆Vpeak has the potential to be the most accurate predictor of fluid responsiveness currently available in children. 1,38,39 Other ultrasound predictors have their applicability limited by the poor evidence supporting their use.…”

“…Although ∆Vpeak presented a higher accuracy when compared to other more traditional dynamic variables, such as SVV or PPV, its acquisition by TTE can be challenging in some circumstances. 1,39 Critically ill patients often have poor acoustic windows due to high positive end-expiratory pressures, interfering incisions, or wound dressings. 46 In addition, ∆Vpeak is a highly operator-dependent variable, requiring specific skills and training.…”

Fatigue After Aneurysmal Subarachnoid Hemorrhage: Clinical Characteristics and Associated Factors in Patients With Good Outcome

“…Item 15, which is not included in the total sum score, indicates which time of the day is felt best and worst if there is a diurnal variation. An MFS sum score of ≥10.5 is suggestive of mental fatigue (Johansson and Ronnback, 2014 ).…”

Predictive Value of the Respiratory Variation in Inferior Vena Cava Diameter for Ventilated Children With Septic Shock

“…The left ventricular stroke volume (SV) was obtained using the following equations: SV = VTI x π(D2)/4. SVV tte has previously been shown to have the diagnostic value for predicting fluid responsiveness in children under mechanical ventilation ( 27 ). SVV tte was the variation of SV during the ventilatory cycle.…”